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Insights into Editorial: Maternal death rate declining: report

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Context:

India’s Maternal Mortality Ratio (MMR) has seen a decline from 130 per 1 lakh live births in 2014-2016 to 122 per 1 lakh live births in 2015-2017.

A decline of 8 points (6.2%) was observed during this period, according to the latest Sample Registration System (SRS) 2015-2017 bulletin for MMR.

This is good news for India as nearly 2,000 maternal deaths have been averted per year, according to the bulletin.

The figure has declined from 167 in 2011-2013 to 130 in 2014-2016 and to 122 in 2015-17, registering a 6.15 per cent reduction since the last survey figures of 2014-2016.

While Karnataka has shown the highest percentage decline in MMR, Uttar Pradesh and Madhya Pradesh have shown an increase by 15 points each in MMR.

Importance of monitoring Maternal Mortality rate:

Maternal mortality in a region is a measure of reproductive health of women in the area.

As per the World Health Organization, maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

One of the key indicators of maternal mortality is the Maternal Mortality Ratio (MMR) which is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period.

The target 3.1 of Sustainable Development Goals (SDG) set by United Nations aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births.

Maternal mortality situation in the country: Categorization of states:

To understand the maternal mortality situation in the country better and to map the changes, especially at the regional level, the government has categorised states into three groups:

  1. Empowered action group (EAG): Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh/Uttarakhand and Assam fall under the EAG.
  2. Southern States: Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu are in the southern States group.
  3. Other states: “Others” comprise the remaining States and Union Territories.

Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh/Uttarakhand and Assam fall under the EAG and Andhra Pradesh, Telangana, Karnataka, Kerala and Tamil Nadu are in the southern States group. “Others” comprise the remaining States and Union Territories.

The decline has been most significant in EAG States from 188 to 175. The ratio has reduced considerably from 77 to 72 per 1,00,000 live births among southern states and in the other states from 93 to 90.

Independent MMR data of Jharkhand (76), Chhattisgarh (141) and Uttarakhand (89) has been released for the first time in the SRS 2015-2017 bulletin.

The Sustainable Development Goals and Maternal Mortality:

In the context of the Sustainable Development Goals (SDG), countries have united behind a new target to accelerate the decline of maternal mortality by 2030.

SDG 3 includes an ambitious target: “reducing the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average”.

Improving maternal health is one of WHO’s key priorities.

WHO works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States on developing and implementing effective policy and programmes.

Reasons for Declining MMR:

Focus on quality and coverage of health services through public health initiatives have contributed majorly to the decline. Some of these initiatives are:

LaQshya, Poshan Abhiyan, Janani Suraksha Yojana, Pradhan Mantri Surakshit Matritva Abhiyan, Pradhan Mantri Matru Vandana Yojana.

The implementation of the Aspirational District Programme and inter-sectoral action has helped to reach the most marginalized and vulnerable population.

Recently launched Surakshit Matritva Aashwasan Initiative (SUMAN) especially focuses on zero preventable maternal and newborn deaths.

The continuous progress in reducing the MMR will help the country to achieve the SDG 3 target of MMR below 70 by 2030.

LaQshya: Labour room Quality Improvement Initiative:

Recently, the Union Ministry of Health and Family Welfare has launched “LaQshya” (Labour room Quality Improvement Initiative) to improve the quality of care in the labour room and maternity operation theatres in public health facilities.

Aim of the LaQshya program is to reduce preventable maternal and newborn mortality, morbidity and stillbirths associated with the care around delivery in the Labour Room and Maternity Operation Theatre (OT) and ensure respectful maternity care.

Conclusion:

In conclusion, throughout this crisis, women will continue to become pregnant and give birth, deserving the right to safe maternity services. This includes physical and emotional safety for the mother and baby.

Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is essential during the outbreak.

Simultaneously, task sharing with community health workers under regulatory and legal provisions must be explored.

E-training mechanisms and capacity building exercises must be undertaken for the additionally requisitioned health workforce to reduce the workload of time-sensitive commitments and non-health work.

Importantly, the health workers must also be trained to reduce the risk, stigma and sensitization of pregnant women on COVID-19 symptoms, prevention and hygiene.